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BOOK REVIEW
SUTURELESS EARLOBE REPAIR BY DR. MJ KOTAK.
Published by Astha Publication, 4, Sarla Niwas, Kisan Nagar No. 1, Wagle Estate, Thane - 400 604.
Ear lobe repair is a very common OPD procedure performed by various surgical specialists and general practitioners from various medical branches. The technique used, their results and cost therefore differ.
Dr. MJ Kotak, uses a particular technique and has described the same in his book ‘Sutureless Earlobe Repair’. In his maiden publication about his experience on a particular topic, Dr. Kotak has shared with us, all the information regarding earlobe hole, its repair, piercing, preventing recurrences, etc. The entire presentation is very systematic, step by step with associated diagrams and photos, which are very neat and self explanatory. The cover page itself looks very attractive, thanks to the beauty of the model and her ‘Binaca smile’. The technique described sounds very simple and the results obtained looks very encouraging.
Though Dr. Kotak needs to be congratulated for his sincere efforts, there are certain points which need to be raised to make the review complete.
1. The attractive front cover page does not suit any scientific medical presentation. It looks more of an advertisement (either for a toothpaste, cosmetic item or jewellery). Also Dr. Kotak should not have identified the model as done by him in the preface as doctors are not supposed to reveal the identity of any person who features in our presentation.
2. There are certain spelling mistakes which need correction such as jewellery, author, together spelled wrongly in the book as jewelry, auther, togather.
3. The exact mode of action of TCAA has not been described.
4. What is the religious reluctance for saline ELR.
5. On page 15 Dr. Kotak states that the skin loss is minimal and therefore the shape of earlobe is maintained. However, on the next page the 1st limitation described is that the scar is not cosmetically acceptable in big ELR due to excessive skin trimming.
6. Trade names of medical products used such as 3M, JMS, Neosporin, Betadine, and Bactroban must be avoided in scientific books.
7. Dr. Kotak would have done justice to explain why he uses three different types of adhesive tapes during the 18-20 days and especially 3M and JMS tapes. I think any one tape could serve the purpose on all the occasions whenever an adhesive tape is required.
8. These tapes as described look non sterile. Can we use unsterile tapes over raw wounds?
9. Dr. Kotak applies Betadine (Povidone Iodine) for 1-2 mins, whereas ideally it takes around 4-5 mins for any suitable antimicrobial action.
10. The main advantages listed are painless, economical, time required comparatively less and comparable results. However, I wonder why a 2 ml local injection with no. 26 needle followed by painless suturing not be more acceptable than the burning sensation on repeated application of TCAA, repeated cleansing with spirit and then exposing the raw area with a surgical knife? I am sure, if one was to quantify the pain, the suture technique would prove to be less painful. As for the economy is concerned, I find it difficult to understand how a repeated visit to a Doctor on many different occasions cost less compared to the cost of suturing done also by a GP. Speciality services would of course be charged as per expertise and qualification. The total duration of 18-20 days is also very long and that is non-economical especially for working ladies, as suture technique would take maximum of 12 days till the last suture is removed. The resultant scar can also be not cosmetically accepted, as in this technique the healing is by secondary intention. The photographs on page 26/28 also shows prominent irregular scars. Hence the results cannot be comparable.
11. Dr. Kotak has claimed very encouraging results but the same needs to be duplicated by other studies before wider acceptance. I would have also liked to know whether Dr. Kotak’s four other colleagues who carried out the incidence study of Ear Lobe hole for him, used this technique and if yes, their result.
To conclude, I do not completely agree with many aspects of this technique in comparison to the traditional suturing method, neverthless, I would like to congratulate Dr. Kotak for an excellent fancy presentation.
Dr. Niranjan Aggarwal
Consultant Surgeon,
Bombay Hospital, MRC, Mumbai 20.
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